title: Intrauterine fetal bradycardia after accidental administration of the anesthetic agent in the subdural space during epidural labor analgesia -A case report-.
abstract: Subdural injection of epidural anesthesia is rare and is usually undiagnosed during epidural anesthesia causing severely delayed maternal hypotension, hypoxia, and fetal distress. A 38-year-old primiparous woman was administered epidural labor analgesia at 40(+6) weeks' gestation, and developed progressive maternal respiratory depression, bradycardia, and hypotension after accidental subdural administration of the anesthetic agent. Furthermore, fetal distress occurred soon after administration. The patient was managed with oxygen, position changes, fluid resuscitation, and ephedrine. Intrauterine fetal resuscitation was successfully performed with atropine before cesarean section, and a healthy baby was delivered. Although subdural injection is uncommon, this case emphasizes the importance of anesthesiologists monitoring patients for a sufficient period after epidural labor analgesia, and being prepared to perform maternal or fetal resuscitation.
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Ho Sik
authors.initials: HS
authors.lastname: Moon
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Chon
authors.forename: Weon Joon
authors.initials: WJ
authors.lastname: Yang
authors.forename: Hae Jin
authors.initials: HJ
authors.lastname: Lee
keywords: Atropine; Epidural analgesia; Fetal bradycardia; Resuscitation; Subdural injection